Jails are no place to treat the mentally ill

A trustee trims the hair of an inmate in the Bexar County Jail mental health unit in 2015 in San Antonio, Texas. County jails in Texas’ more populous counties are trying to treat the mentally ill in their custody but this isn’t the proper place.

Photo: JERRY LARA /Associated Press

Simply put, we are failing people with mental illness and the Texas taxpayers who contribute to their care. But we can change that.

Let’s be clear: Incarceration and punishment don’t treat mental illness any more than they treat diabetes or cancer. Yet jails in Texas and across the nation are serving as our largest mental health institutions.

JPS Health Network is Tarrant County’s publicly supported health care system, offering services in an acute care hospital and more than 40 primary and specialty clinics. In addition to being our community’s only Level 1 trauma center, we operate the only psychiatric emergency center, as well as inpatient and outpatient behavioral health services. We experience about 8,200 behavioral health patient encounters every month, with about 1,500 of those in the psychiatric emergency center.

This is not just a Texas issue. A 2015 study by Mental Health America revealed people with mental illness account for more than half of the populations in county jails across the country.

In Texas, that’s 38,000 people who suffer from mental illness and repeatedly end up in jail. Many are accused of nonviolent offenses because their illness may trigger behavior outside of accepted norms.

Often law enforcement has to arrest them because no viable treatment options are available. Texas is spending $650 million annually in local justice system costs for only 38,000 people whose mental illness and substance use disorders are inadequately treated, according to the Meadows Mental Health Policy Institute, or MMHPI.

At the Tarrant County Jail, MHMR of Tarrant County provides mental health screening and treatment for inmates to the tune of $2.3 million a year.

The Harris County Jail, where more than a quarter of the 9,000 or so inmates take medication for mental illness, can treat almost 250 inmates a day in its Mental Health Unit.

Such services aren’t available for many counties and are often nonexistent for municipal jails.

Broader, more proactive strategies are required to reduce those entering the criminal justice system with mental illness. However, diversion is not a practical solution when inpatient and community-based care options for Texans with mental illness are inadequate.

People who are evaluated as not competent (known as forsenic patients) to stand trial stay in jail until a state hospital bed is available. As many as 400 forensic patients may be waiting in jail rather than receiving restorative care due to the lack of available state hospital beds and funding for local competency-restoration options.

The picture is equally bleak for those who need access to state hospital beds because of a civil commitment. In 2014, the number of state hospital beds occupied by forensic patients surpassed the number used by civilly committed patients.

With lengths of stays four to five times longer for forensic patients, this trend will all but eliminate access to state hospital beds for those committed through the civil process.

The state’s 2015 study found an unmet state hospital bed need of 570, with an additional 607 beds needed to keep up with population growth over the next 10 years. On any given day, eight to 10 people in our community are waiting for a bed at the state hospital.

As if our overuse of jails and the lack of inpatient beds are not challenging enough, our efforts are going to continue to be thwarted unless we address our state’s inadequate behavioral health workforce.

According to an analysis reported in the Hogg Foundation’s Mental Health Workforce in Texas Policy Brief, 206 of 254 Texas counties were designated as full or partial mental health professional shortage areas, with 185 Texas counties not having a single psychiatrist in 2015.

That left more than 3 million Texans in counties without access to a psychiatrist. MMHPI identified Texas has having only 76 psychiatrists per million residents, compared to the national average of 129 psychiatrists per million residents.

Recent bills in the Texas Legislature to create loan repayment programs for psychiatric residents are a great start, but they aren’t enough. We must fund additional psychiatry residency slots, enhance the ability to use technology to deliver care, create reciprocity for psychiatrists licensed in other states, and find incentives to retain those who complete medical school and/or a residency in our great state.

Robert Earley is president and CEO of JPS Health Network, Tarrant County’s publicly supported health care system. A former state legislator, he serves on the board of Meadows Mental Health Policy Institute.